Provider Demographics
NPI:1558975128
Name:BAIR, JESSICA ANN (CMS)
Entity Type:Individual
Prefix:MISS
First Name:JESSICA
Middle Name:ANN
Last Name:BAIR
Suffix:
Gender:F
Credentials:CMS
Other - Prefix:MISS
Other - First Name:JESSICA
Other - Middle Name:A
Other - Last Name:KNIGHT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4606 GIFFORD AVE
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44144-2944
Mailing Address - Country:US
Mailing Address - Phone:216-215-7344
Mailing Address - Fax:
Practice Address - Street 1:4606 GIFFORD AVE
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44144-2944
Practice Address - Country:US
Practice Address - Phone:216-215-7344
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-01
Last Update Date:2020-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH175T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist